Laryngeal mask airway

ABSTRACT

A laryngeal mask airway has a curved tubular guide for insertion through the patient&#39;s mouth and oropharynx. After insertion of the guide, the beveled distal opening of the guide abuts the laryngeal inlet, while the guide&#39;s proximal opening remains outside the patient&#39;s mouth. A laryngeal mask surrounds the distal opening of the guide to substantially seal the laryngeal inlet about the distal opening of the guide A ventilation port adjacent to the proximal opening of the guide supplies air/oxygen through the guide into the patient&#39;s lungs. An endotracheal tube can then be advanced along the length of guide and through the patient&#39;s larynx without interrupting ventilation.

BACKGROUND OF THE INVENTION

[0001] 1. Field of the Invention

[0002] The present invention relates generally to the field of laryngealmask airways. More specifically, the present invention discloses anintubation guide and laryngeal mask that can be used to simultaneouslyintubate and ventilate a patient.

[0003] 2. Background of the Invention

[0004] Endotracheal tubes are often used in semi-emergency situations toventilate patients with respiratory failure who may be conscious orsemi-conscious. The conventional approach requires the patient to liestill while the physician inserts a rigid laryngoscope blade into thepatient's mouth and trachea. Delivery of ventilation and/or oxygen isalso interrupted during this period. The endotracheal tube is theninserted into place while the laryngoscope blade keeps the patient'sairway open. Successful intubation depends on the patient beingcooperative and completely relaxed, which unfortunately is often not thecase. Even with a cooperative patient, intubation is very uncomfortableand can cause the patient to panic due to the difficulty in breathingduring the procedure. This procedure can also result in a choking orgagging response that can cause the patient to regurgitate and aspiratecontents from the stomach. One conventional response to theseshortcomings has been to sedate the patient during intubation.Tranquilizers make the patient more cooperative and less likely to chokeduring intubation, but also tend to suppress the patient's breathing andblood pressure. These side effects may be unacceptable when dealing witha patient who already suffers from shallow or irregular breathing ordepressed blood pressure. Therefore, a need exists for an improveddevice to guide insertion of an endotracheal tube and ensure that thepatient's airway is open, and that also allows the patient to continueto receive air/oxygen during the insertion process.

[0005] Laryngeal masks have also been used for many years for severalpurposes. For example, laryngeal mask airways have been used toventilate patients while preventing aspiration of secretions or stomachcontents into the lungs. Some types of intubation guides include alaryngeal mask to seal the laryngeal inlet while directing theendotracheal tube into position through the larynx.

[0006] Prior Art. The prior art in the field includes the following:U.S. Pat. No. Inventor 4,240,417 Holever 4,351,328 Bodai 4,416,273Grimes 4,509,514 Brain 4,848,331 Northway-Meyer 4,995,388 Brain5,197,463 Jeshuran 5,241,956 Brain 5,249,571 Brain 5,282,464 Brain5,297,547 Brain 5,303,697 Brain 5,305,743 Brain 5,391,248 Brain5,355,879 Brain 5,584,290 Brain 5,632,271 Brain 5,642,726 Owens et al.5,682,880 Brain 5,711,293 Brain 5,771,889 Pagan 5,871,012 Neame et al.5,878,745 Brain 5,881,726 Neame et al. 5,890,488 Burden 5,896,858 Brain5,937,860 Cook 5,979,445 Neame et al. 5,983,897 Pagan 6,012,452 Pagan6,050,264 Greenfield 6,055,984 Brain 6,079,409 Brain 6,116,243 Pagan

[0007] Holever discloses an adaptor to connect a ventilator to anendotracheal tube, while also permitting insertion of a suction tube.

[0008] Bodai discloses a system for simultaneous ventilation andendotracheal suctioning of a patient.

[0009] Grimes discloses a connector valve assembly for endotrachealtubes.

[0010] The Brain '514 patent discloses a laryngeal mask with a generallyelliptical shape and a guide tube.

[0011] Northway-Meyer discloses a face mask and intubation guide, whichincludes a connector for ventilation through the face mask andintubation guide.

[0012] Brain '388 patent discloses a laryngeal mask with a soft flexiblecollar surrounding the lumen of the mask, and also having a drainagetube.

[0013] Jeshuran discloses a face mask and adaptor for endotrachealintubation.

[0014] The Brain '956 patent discloses a laryngeal mask airway withconcentric drainage for esophageal discharge.

[0015] The Brain '571 patent discloses a laryngeal clamp airway.

[0016] The Brain '464 patent discloses a combined laryngeal mask andreflectance oximeter.

[0017] The Brain '547 patent discloses a laryngeal mask with aninflatable cuff and a V-shaped posterior side.

[0018] The Brain '697 patent discloses a laryngeal mask with a rigidhandle at the proximal end of the guide tube.

[0019] The Brain '743 and '248 patents disclose a molding process forproducing laryngeal masks.

[0020] The Brain '879 patent discloses a laryngeal mask with inflatablering and inflatable back cushion.

[0021] The Brain '290 patent discloses a laryngeal mask with electrodes.

[0022] The Brain '271 patent discloses a laryngeal mask with a gastricdrainage feature.

[0023] The Brain '880 patent discloses a laryngeal mask with a removablestiffener that can be attached to the guide.

[0024] The Brain '293 patent discloses a forming tool for deflating alaryngeal mask, such as that shown in the Brain '547 patent, prior toinsertion.

[0025] The Pagan '889 patent discloses a mask assembly having aninflatable ring and a diaphragm attached to a backing plate.

[0026] The '012 patent to Neame et al. discloses a laryngeal mask withan inflatable bag.

[0027] The Brain '745 patent discloses a gastro-laryngeal mask with aninflatable cuff and a back cushion to engage the back wall of thepharynx.

[0028] The '726 patent to Neame et al. discloses a laryngeal mask with acuff formed by interlocking ribs.

[0029] Burden discloses a coupling device for placing a stethoscope andan endotracheal tube in gaseous communication.

[0030] The Brain '858 patent discloses a laryngeal mask with a hingedbar to elevate the epiglottis.

[0031] Cook discloses a laryngeal mask with an inflatable toroidalperipheral portion having a recessed front notch.

[0032] The '445 patent to Neame et al. discloses a method formanufacture of a laryngeal mask in which the edges of the cuff areheat-sealed.

[0033] The Pagan '897 patent discloses a laryngeal mask with cuffsattached on both sides of a plate. The plate also forms a leading tip.

[0034] The Pagan '452 patent discloses a laryngeal mask with an air lineextending to a foam cuff. The cuff can be compressed for insertion byapplying suction to the air line.

[0035] Greenfield discloses a laryngeal mask requiring an obduratorinserted into the tube.

[0036] The Brain '984 patent discloses an endotracheal tube havingtapered, closed nose with a triangular cross-section and lateralopenings.

[0037] The Brain '409 patent discloses a laryngeal mask having aspecific geometry for the guide tube and mask.

[0038] The Pagan '243 patent discloses a laryngeal mask with a plateseparating two separate semi-annular cuffs bonded to opposite sides ofthe plate.

[0039] Solution to the Problem. None of the prior art referencesdiscussed above teaches or suggests a laryngeal mask airway that enablesthe patient to continue to be ventilated while being intubated. Thissystem allows the endotracheal tube to be inserted and connected to aventilator without interrupting the flow of air/oxygen to the patient'slungs.

SUMMARY OF THE INVENTION

[0040] This invention provides a laryngeal mask airway having a curvedtubular guide for insertion through the patient's mouth and oropharynx.After insertion of the guide, the beveled distal opening of the guideabuts the laryngeal inlet, while the guide's proximal opening remainsoutside the patient's mouth. A laryngeal mask surrounds the distalopening of the guide to substantially seal the laryngeal inlet about thedistal opening of the guide. A ventilation port adjacent to the proximalopening of the guide supplies a flow of air/oxygen through the guideinto the patient's lungs. An endotracheal tube can then be advancedalong the length of guide and through the patient's larynx withoutinterrupting ventilation.

[0041] These and other advantages, features, and objects of the presentinvention will be more readily understood in view of the followingdetailed description and the drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

[0042] The present invention can be more readily understood inconjunction with the accompanying drawings, in which:

[0043]FIG. 1 is a front perspective view of a laryngeal mask airway 10with a rotatable collar 14 for delivery of air/oxygen through the guide12.

[0044]FIG. 2 is rear perspective view of the laryngeal mask airwaycorresponding to FIG. 1.

[0045]FIG. 3 is a cross-sectional view of the laryngeal mask airway 10corresponding to FIG. 1 with the mask 30 inflated.

[0046]FIG. 4 is a detail cross-sectional view of the distal portion ofthe laryngeal mask airway 10.

[0047]FIG. 5 is a perspective view of a resuscitation attachment 70 thatcan be connected to the ventilation port 16 of the laryngeal mask airway10.

[0048]FIG. 6 is a corresponding side view of the resuscitationattachment 70 with flexible tubing 80 having a mouthpiece 84 forresuscitation of the patient.

[0049]FIG. 7 is a detail side view of an embodiment of the resuscitationattachment 70 having an oxygen port 76.

[0050]FIG. 8 is an exploded perspective view of the removable guide cap91 that can be inserted into the proximal opening of the guide 12 of thelaryngeal mask airway 10.

[0051]FIG. 9 is a cross-sectional view of the removable guide cap 91corresponding to FIG. 8.

[0052]FIG. 10 is a front perspective view of another embodiment of thelaryngeal mask airway 10 in which the ventilation port 16 is fixedrelative to the guide 12.

[0053]FIG. 11 is a rear perspective view of the laryngeal mask airway 10corresponding to FIG. 10.

[0054]FIG. 12 is a front perspective view of another embodiment of thelaryngeal mask airway without a ventilation port.

[0055]FIG. 13 is a top perspective view of a patient's airway showingthe inlet to the larynx, esophagus, and epiglottis.

[0056]FIG. 14 is a cross-sectional view of a patient's airway after thelaryngeal mask airway 10 has been initially inserted.

[0057]FIG. 15 is a cross-sectional view of the laryngeal mask airway 10and the patient's airway corresponding to FIG. 14 after the mask 30 hasbeen inflated.

[0058]FIG. 16 is a cross-sectional view of the patient's airway andlaryngeal mask airway 10 corresponding to FIGS. 14-15 showing a syringe55 connected to the guide cap 91 on the laryngeal mask airway 10 tosquirt anesthetic through the laryngeal mask airway 10 and into thepatient's airway to lessen discomfort.

[0059]FIG. 17 is a cross-sectional view of the laryngeal mask airway 10and the patient's airway corresponding to FIGS. 14-16 after anendotracheal tube 40 has been inserted through the laryngeal mask airway10.

[0060]FIG. 18 is a cross-sectional view of the laryngeal mask airway 10and the patient's airway corresponding to FIGS. 14-17 after theendoscope probe 50 has been withdrawn from within the endotracheal tube40.

[0061]FIG. 19 is a cross-sectional view of the laryngeal mask airway 10and the patient's airway corresponding to FIGS. 14-18 after the mask 30has been deflated and the laryngeal mask airway 10 has been removed,leaving the endotracheal tube 40 in place in the patient's airway.

[0062]FIG. 20 is a cross-sectional view of the patient's airwaycorresponding to FIGS. 14-19 after the cuff 42 of the endotracheal tube40 has been inflated and the patient has been connected to a ventilator48.

[0063]FIG. 21 is a cross-sectional view of the patient's airwaycorresponding to FIG. 14-20 in an alternative methodology in which thelaryngeal mask airway 10 is withdrawn over the endoscope probe 50 whileleaving the endotracheal tube 40 in place in the patient's airway.

[0064]FIG. 22 is a perspective view of the stabilizer 52 that can beattached to an endoscope probe 50 to advance the endotracheal tube 40along the laryngeal mask airway 10

[0065]FIG. 23 is a perspective view of the endotracheal tube cap 45 thatcan be used in conjunction with a stabilizer 52 to advance theendotracheal tube 40.

[0066]FIG. 24 is an exploded perspective view of an embodiment of thepresent invention in which a separate ventilation attachment 100 caneither be used in combination with a guide 12 or a conventionallaryngeal mask airway 102.

[0067]FIG. 25 is an exploded cross-sectional view corresponding to FIG.24.

[0068]FIG. 26 is a cross-sectional view of a ventilation attachment 100having a fixed ventilation port 16.

[0069]FIG. 27 is a cross-sectional view corresponding to FIG. 26 showinginsertion of an endotracheal tube 40 through the ventilation attachment100.

[0070]FIG. 28 is a cross-sectional view of a laryngeal mask airway 10with a removable ventilator connector 110 attached to its proximal endin place of the ventilation attachment 100.

DETAILED DESCRIPTION OF THE INVENTION

[0071] Structure of the Laryngeal Mask Airway. Turning to FIGS. 1 and 2,front and rear perspective views are provided of a laryngeal mask airway10 in accordance with the present invention. This embodiment includes atubular guide 12 with a laryngeal mask 30 surrounding its distal end.FIG. 3 is a corresponding cross-sectional view of the laryngeal maskairway 10 with the laryngeal mask 30 inflated. FIG. 4 is a detail endview of the laryngeal mask 30 and the distal portion of the guide 12.The size and shape of the guide 12 are selected so that its distalportion can be readily inserted into the patient's mouth and upperairway with the laryngeal mask 30 substantially sealing the laryngealinlet 27, as shown in FIGS. 14-18. The proximal end of the guide 12remains outside of the patient's mouth and therefore is accessible tothe healthcare provider.

[0072] The guide 12 is generally J-shaped to follow the profile of atypical patient's airway through the mouth, over the tongue 22, and intothe laryngopharynx 21 just above the opening to the larynx 24 (see FIGS.13 and 14). The guide 12 is shaped to prevent the patient's tongue 22and collapsible pharynx from obstructing access to the trachea, whilealso defining a channel for later insertion of an endotracheal tube. Theguide 12 is typically made of plastic with sufficient strength andrigidity to keep the patient's teeth apart and prevent the patient frombiting down on the endotracheal tube. This flexibility allows the guide12 to accommodate a wide range of patient sizes and conditions. Theinside diameter of the guide 12 should be sufficiently large to allow anendotracheal tube 40 to freely pass through the guide 12, as shown forexample in FIG. 17, with extra room to allow air/oxygen to flow throughthe guide 12 around the endotracheal tube 40. Preferably, the distalopening of the guide 12 is beveled to substantially match the angle ofthe laryngeal inlet 27 after insertion of the laryngeal mask airway 10into the patient's airway.

[0073] The laryngeal mask 30 consists a central support member 31extending outward from the guide 12 to an inflatable member asillustrated in FIGS. 1-4. The laryngeal mask 30 is preferably made of asoft, flexible material (e.g., a polymer or rubber) to enable it to beadvanced into position without injury to the patient and to create asubstantially air-tight seal about the laryngeal inlet 27. The degree ofinflation of the laryngeal mask 30 can be adjusted through a smallinflation tube 34 and air valve 32. Alternatively, the laryngeal mask 30can be a cushion made of a soft, spongy material that is not inflatable.The laryngeal mask 30 and its support member 31 are shaped to meetseveral requirements. The lower portion 35 of the laryngeal mask 30substantially blocks the esophagus to minimize the risk of regurgitationof stomach contents and the passage of air into the stomach. The upperportion 36 of the laryngeal mask 30 guides the distal end of the guide12 into alignment with the laryngeal inlet 27 as the guide is insertedalong the patient's airway.

[0074] In the embodiment shown in the drawings, the laryngeal mask 30 isgenerally boot-shaped when inflated. The lower portion 35 of thelaryngeal mask 30 forms the toe of the boot, which blocks the esophagus.The lower portion 35 of the laryngeal mask 30 also helps to align thedistal opening of the guide 12 with the patient's laryngeal inlet 27.After the mask 30 is inflated, the upper portion 36 of the mask 30substantially fills the laryngopharynx 21 at the level of the laryngealinlet 27. The upper portion 36 of the laryngeal mask 30 surrounds thelaryngeal inlet 27 so that the distal opening of the guide 12 is sealedin fluid communication with the laryngeal inlet 27. Thus, substantiallyall of the gas inhaled or exhaled by the patient passes through theguide 12. For example, the laryngeal mask 30 can be formed by injectionblow molding, rotational molding, or dip molding.

[0075] In particular, the upper portion 36 of the mask 30 surroundingthe distal opening of the guide 12 is canted at an angle to complementthe natural angle of the laryngeal inlet 27. The distal end of the guide12 can also be beveled at this complementary angle. This enables thelaryngeal mask airway 10 to directly engage the laryngeal inlet 27 alongthe longitudinal axis of the patient's airway as the guide 12 isadvanced. The shape of the upper portion 36 of the laryngeal mask 30further helps to guide the distal opening of the guide 12 so that it isaxially aligned with the laryngeal inlet 27 and abuts the laryngealinlet 27 in an end-on relationship as the guide is inserted along thepatient's airway. In contrast, conventional laryngeal masks typicallyapproach the laryngeal inlet 27 from a posterior or inferior position.

[0076] In the embodiment depicted in FIGS. 1-4, the proximal end of theguide 12 can be sealed by a removable guide cap 91 as shown in FIG. 8,9, and 14. FIG. 8 is an exploded perspective view of the guide cap 91,while FIG. 9 is provides a cross-sectional view of the guide cap 91.FIG. 14 is a cross-sectional view of a patient's airway after thelaryngeal mask airway 10 has been initially inserted. As shown in FIG.14, the guide cap 91 has an outside diameter dimensioned to seat intothe proximal opening of the guide 12 and thereby prevent the escape ofgas through this opening. When inserted, the guide cap 91 abuts andseals against an annular seal ring 13 within the guide 12 as illustratedin FIG. 14. The guide cap 91 has a small passageway or port extendingvertically through the guide cap 91. As shown in FIG. 9, a luerconnector 92 with a one-way valve 93 (e.g., a duck-bill valve) ispermanently attached to the guide cap 91 so that air or fluid can onlyflow down the passageway of the guide cap 91, but not up. Thus, theone-way valve 93 serves to prevent air/oxygen from escaping through theguide 12 during resuscitation.

[0077] As illustrated in FIG. 16, a syringe 55 containing anesthetic canbe secured to the luer connector 92 on the guide cap 91. As the guide 12is advanced into the patient's mouth and hypopharynx, the healthcareprovider squirts anesthetic from the syringe 55, through the one-wayvalve 93 and guide 12 to lessen discomfort. After the guide 12 has beenadvanced into position, the guide cap 91 is removed from the guide 12 toallow insertion of an endotracheal tube 40 and fiber optic probe 50through the guide 12, as will be discussed below.

[0078] A flow of air/oxygen is delivery to the patient via the guide 12through a ventilation port 16 extending at an angle from the side of theguide 12. A rotatable collar 14 allows the ventilation port 16 to berotated about the central axis of the guide 12 to any desiredorientation. Air/oxygen flows through the ventilating port 16 into theannular space between the collar 14 and the guide 12, and through aseries of ventilation holes 18 into the interior of the guide 12, asshown in greater detail in FIG. 3. For example, the ventilation port 16can be connected to a conventional ventilator or a resuscitation bag.

[0079] Resuscitation Attachment. Alternatively, a mouthpiece can beconnected to the ventilation port 16 for initial patient resuscitationby a healthcare provider. For example, FIG. 5 is a perspective view of aresuscitation attachment 70 that can used in place of a ventilator orresuscitation bag for resuscitation by the healthcare provider. Theresuscitation attachment 70 has an output port 71 that can be removablyconnected to the ventilation port 16 of the laryngeal mask airway 10.The resuscitation attachment 70 includes an air filter 74 across theflow path between the input port 72 and output port 71 to help preventthe exchange of contaminants between the healthcare provider andpatient. A one-way valve 75 (e.g., a duckbill valve) directs anybackflow of air or contaminated fluids from the patient to the exhaustport 73, and thereby serves to further protect the healthcare providerfrom contaminants.

[0080] The healthcare provider can breathe directly into the input port72 of the resuscitation attachment 70. Alternatively, a length offlexible tubing 80 can be connected to the resuscitation attachment 70by means of a connector 82 that can be plugged into the input port 72 ofthe resuscitation attachment 70, as shown in FIG. 6. In the preferredembodiment, the flexible tubing 80 is approximately six inches in lengthand forms a helical coil for easier storage. The proximal end of theflexible tubing 80 has a mouthpiece 84 with an oval opening.

[0081] The resuscitation attachment 70 can also be equipped with anoxygen port 76, as shown in FIG. 7, that can be connected by tubing to aexternal oxygen source to supply supplemental oxygen to the patientthrough the flow path, in addition to the resuscitation provided by thehealthcare provider. Each exhalation by the healthcare provider thencarries oxygen-enriched air through the laryngeal mask airway 10 andinto the patient's lungs. The oxygen port 76 can be closed with aremovable cap 77 when the oxygen port 76 is not in use. The internalpassageway within the flexible tubing 80 and resuscitation attachment 70upstream from the one-way valve 75 serve as a reservoir for accumulationof oxygen between each exhalation by the healthcare provider.

[0082]FIG. 7 shows an embodiment of the resuscitation attachment 70 withthe oxygen port 76 placed below the one-way valve 75 and filter 74. Inthis embodiment, the internal passageway within the resuscitationattachment 70 downstream from the one-way valve 75 serves as a reservoirfor accumulation of oxygen between each exhalation by the healthcareprovider. The one-way valve 75 helps to prevent oxygen from escapingduring the remainder of the resuscitation cycle. However, the exhaustport 73 prevents a build-up of excessive pressure that might beinjurious to the patient's lungs.

[0083]FIGS. 10 and 11 are front and rear perspective views of anotherembodiment of the laryngeal mask airway 10 in which air/oxygen isintroduced directly into the guide 12 through a fixed ventilation port16. This embodiment would be simpler and less expensive to build.

[0084]FIG. 12 is a front perspective view of yet another embodiment ofthe laryngeal mask airway 10 without a separate ventilation port. Thepatient can be supplied with air/oxygen through a connector or capplaced in the proximal opening of the guide 12. Alternatively, thepatient can be intubated without ventilation.

[0085] Method Of Use For The Laryngeal Mask Airway. The following is adescription of a typical method of use for the laryngeal mask airway 10.

[0086] The curved distal portion of the guide 12 is first inserted intothe patient's mouth and laryngopharynx 21 with the laryngeal mask 30deflated, as shown in FIG. 14. If necessary, the ventilation port 16 canbe used as a hand grip during insertion of the guide 12. FIG. 13 is acorresponding top perspective view of a patient's airway, including thelarynx 24, esophagus 23, and epiglottis 25. The positions of the guide12 and laryngeal mask 30 relative to the patient's anatomy afterinsertion are shown in dashed lines in FIG. 13. The lower portions ofthe support member 31 and laryngeal mask 30 extend into the esophagus23. The upper portions of the support member 31 and the laryngeal mask30 surround the laryngeal inlet 27.

[0087] A protrusion 33 on the anterior portion of the distal tip of theguide 12 or support member 31 is inserted to the patient's vallecula 26(i.e., the notch between the base of the tongue 22 and the epiglottis25. The protrusion 33 pushes on the vallecula 26, which tends to liftthe epiglottis 25 from the laryngeal inlet 27 and helps to ensurepatency of the patient's airway.

[0088] After the distal portion of the guide 12 and the laryngeal mask30 are appropriately positioned relative to the laryngeal inlet 27, thelaryngeal mask 30 is inflated via the inflation tube 34 to establish aseal around the laryngeal inlet 27, as depicted in FIG. 15. The lowerportion 35 of the inflated laryngeal mask 30 substantially blocks theesophagus 23. The upper portion 36 of the inflated laryngeal mask 30substantially fills the laryngopharynx 21 adjacent to the laryngealinlet 27, and thereby seals the distal opening of the guide 12 in fluidcommunication with the laryngeal inlet. The side portions 37 and 38(shown in FIG. 4) pinch the sides of the epiglottis 25, which also tendsto lift the epiglottis 25 from the laryngeal inlet 27.

[0089] If necessary, the guide cap 91 can be removed and an endoscopeprobe can be inserted through the proximal end of the guide 12 to enablethe physician to view the insertion process and verify that thelaryngeal mask 30 is correctly positioned.

[0090] Optionally, a syringe 55 containing a local anesthetic (e.g.,lidocaine or xylocaine) can be connected to the luer connector on theguide cap 91 at the proximal end of the guide 12 to squirt anesthetic asthe guide 12 is inserted through the patient's mouth and into thelaryngopharynx 21, as shown in FIG. 16. If squirted with sufficientforce, the anesthetic can be carried as far as the larynx 24 to deadenany discomfort associated with insertion of the laryngeal mask airway 10and endotracheal tube 40.

[0091] During and after insertion of the guide 12, the patient can beresuscitated by supplying air/oxygen through the ventilation port 16.For example, the flow of air can be supplied by a resuscitation bagattached to the ventilation port 16 that is manually squeezedperiodically to simulate natural breathing. Alternatively, aresuscitation attachment (such as shown in FIGS. 5-7) can be removablyattached to the ventilation port 16 to enable a healthcare provider todirectly resuscitate the patient.

[0092] After the patient's condition has been stabilized to some degreeduring initial resuscitation, an endotracheal tube 40 is inserted overthe distal end of an endoscope probe 50. The guide cap 91 is removedfrom the proximal end of the guide 12. Resuscitation, oxygenation, orartificial ventilation continue without interruption while the endoscopeprobe 50 and endotracheal tube 40 are advanced along the guide 12 andthrough the laryngeal mask 30 to a position within the trachea past thelarynx 24. FIG. 17 is a cross-sectional view of the laryngeal maskairway 10 during insertion of the endotracheal tube 40 and endoscopeprobe 50.

[0093] The seal ring 13 within the proximal end of the guide 12 has aninside diameter that is only slightly larger than the outside diameterof the endotracheal tube 40. This maintains a sufficiently tight fitaround the endotracheal tube 40 to prevent the escape of gas through theseal. However, air/oxygen flows freely through the space between theendotracheal tube 40 and the surrounding guide 12 to maintain patientrespiration.

[0094] Optionally, a removable cap 45 can be inserted into the proximalend of the endotracheal tube 40 and a stabilizer tube 52 can be attachedto the endoscope probe 50, as shown in FIG. 17, to assist in advancingthe endotracheal tube 40 along the guide 12. In the preferredembodiment, the stabilizer 52 is a flexible plastic tube having aC-shaped cross-section, as shown in FIG. 22, that can be readily clippedover the fiber optic probe 50 at any desired location along its length.The inside diameter of the stabilizer 52 should be selected to provide asnug, frictional fit against the exterior of the endoscope probe 50 sothat the stabilizer 52 will not readily slide after it has been attachedto the fiber optic probe 50. The stabilizer 52 can also be readilyremoved from the endoscope probe 50 by the healthcare provider forcleaning or to adjust its location on the probe 50. The stabilizer 52should have outside dimensions sufficiently large to push theendotracheal tube 40 forward as the fiber optic probe 50 is advanced bythe healthcare provider.

[0095] The proximal end of the endotracheal tube 40 can be fitted with aremovable cap 45 shown in FIG. 23. This cap 45 has outside dimensionsselected so that it can be inserted snugly into the proximal opening ofthe endotracheal tube 40 and yet is sufficiently small to pass throughthe guide 12, if necessary. A central passageway extends axially throughthe endotracheal tube cap 45 to receive the endoscope 50. The endoscopeprobe 50 passes freely through the cap 45. However, the cap passagewayhas an inside diameter smaller than the stabilizer 52, so that thestabilizer 52 will abut and push against the proximal end of theendotracheal tube 40 as the fiber optic probe 50 is advanced by thehealthcare provider. This approach enables the endotracheal tube 40 andendoscope probe 50 to be advanced along the guide 12 and patient'sairway as a single assembly.

[0096] The shape of the guide 12, the support member 31, and laryngealmask 30 tend to align the distal opening of the guide 12 with the larynx24 so that the endoscope probe 50 and endotracheal tube 40 will passthrough the opening between the vocal cords. However, after emergingfrom the distal end of the guide 12, the direction of the distal tip ofthe endoscope probe 50 can be controlled by the physician. This allowsthe physician to carefully guide the endoscope probe 50 and endotrachealtube 40 to a position past the larynx 24 while resuscitation continues.Many conventional endoscopes include a suction channel extending thelength of the fiber optic probe to its distal tip. This feature can beused to suction mucus or other secretions from the patient's airway asthe endoscope/endotracheal tube assembly is inserted. Alternatively, anendoscope 50 may not be needed at all due to the anatomical alignmentprovided by the laryngeal mask 30, which permits “blind” intubation ofthe patient. In any event, the patient is being ventilated throughoutthe intubation process, so the normal risks associated with intubationare not as serious if delays are encountered in completing theintubation process using the present invention.

[0097] In one methodology, the endoscope probe 50 is then removed fromwithin the endotracheal tube 40, as shown in FIG. 18. The laryngeal mask30 is deflated and the guide 12 is removed while leaving theendotracheal tube 40 in place within the trachea, as illustrated in FIG.19. Alternatively, the guide 12 can be left in place to serve as an oralairway and to protect the endotracheal tube 40 from being bitten by thepatient's teeth. However, the laryngeal mask 30 should be deflated ifthe device is to be left in place in the patient's airway for anextended period time to minimize damage to the mucous lining.

[0098] The cuff 42 on the endotracheal tube 40 is then inflated via aninflation tube 44 and air valve 46. Finally, a ventilator 48 isconnected to the proximal end of the endotracheal tube 40 to ventilatethe patient, as shown in FIG. 20. Alternatively, the patient can bemanually ventilated by connecting a resuscitation bag to the proximalend of the endotracheal tube 40.

[0099]FIG. 21 depicts an alternative methodology in which the laryngealmask airway 10 is withdrawn over the endoscope probe 50 while leavingthe endotracheal tube 40 in place in the patient's airway. In thismethodology, after the endotracheal tube 40 has been moved into positionwith its distal end in the trachea as illustrated in 17, the laryngealmask 30 is deflated and the guide 12 is removed over the proximal end ofthe endotracheal tube 40 while leaving the endotracheal tube 40 andfiber optic probe 50 in place. Before removing the guide 12, thehealthcare provider may wish to slide the stabilizer 52 a fewcentimeters toward the distal end of the fiber optic probe 50. Thisallows the endoscope 50 to be pulled back relative to the endotrachealtube 40, so that the distal tip of the endoscope 50 is located withinthe distal end of the endotracheal tube 40 and offers a view of both theendotracheal tube's distal tip and the patient's trachea. This enablesthe healthcare provider to monitor the position of the endotracheal tube40 relative to the trachea as the guide 12 is removed, as describedabove.

[0100] The fiber optic probe 50 is then withdrawn from within theendotracheal tube 40 and the endotracheal tube cap 45 is removed if oneis present. Finally, the patient can be ventilated via a conventionalventilator 48 connected to the endotracheal tube 40, as shown in FIG.20.

[0101] Ventilation Attachment. FIG. 24 is an exploded perspective viewof an embodiment using a separate ventilation attachment 100 with arotatable ventilation port 16. FIG. 25 is an exploded cross-sectionalview corresponding to FIG. 24. The ventilation attachment 100 providesthe same functionality as the proximal portion of the laryngeal maskairway 10 in the previous embodiments. The ventilation attachment 100has a passageway with a diameter large enough to allow an endotrachealtube to pass through the ventilation attachment 100. A ventilation port16 allows a flow of air/oxygen to be supplied through the guide 12around the periphery of the endotracheal tube and into the patient'slungs during insertion of the endotracheal tube, as previouslydiscussed. A seal ring 13 in the passageway forms a seal around theendotracheal tube as the endotracheal tube is inserted through theventilation attachment 100 and along the guide 12. In other words, theseal ring 13 provides a seal around the endotracheal tube as it isinserted through the ventilation attachment 100 to prevent air/oxygenfrom escaping from within the passageway while the patient is beingventilated. But, the seal ring 13 allows the endotracheal tube to beadvanced through the ventilation attachment 100 and guide 12 withminimal resistance.

[0102] The ventilation attachment 100 can either be used in combinationwith a J-shaped guide 12 similar to that shown in the previousembodiments, or with a conventional laryngeal mask airway 102. If usedin combination with the J-shaped guide 12, the cuff 101 at the lower endof the ventilation attachment 100 fits directly over the proximalopening of the guide 12. In contrast, conventional laryngeal maskairways 102 typically have a standard 15 mm respirator connector (notshown) at their proximal end, which may or may not be removabledepending on the specific model involved. If possible, the respiratorconnector should be removed from the end of the laryngeal mask airway102, as illustrated in FIG. 24 to provide a larger diameter forsubsequent insertion of an endotracheal tube. If the respiratorconnector cannot be removed from the end of the laryngeal mask airway102, the ventilation attachment 100 can be attached over the respiratorconnector. If necessary, a tubular adapter 103 can be inserted betweenthe cuff 101 of the ventilation attachment 100 and the upper end of theguide to accommodate any change in diameter between the cuff 101 and theend of the guide.

[0103] It should be understood that the term “guide” encompasses anytype of guide or laryngeal mask airway for the purposes of thisinvention. In either case, the cuff 101 serves to coaxially align thepassageway of the ventilation attachment 100 with the guide, so that anendotracheal tube can be inserted through both.

[0104] The embodiment illustrated in FIGS. 24-25 includes a rotatablecollar 14 so that the ventilation port 16 can be rotated to any desiredorientation relative to the longitudinal axis of the guide. In contrast,FIG. 26 is a cross-sectional view of an embodiment of the ventilationattachment 100 having a fixed ventilation port 16. The orientation ofthe ventilation port 16 can be adjusted by rotating the cuff 101 (andtherefore the entire ventilation attachment 100 including theventilation port 16) relative to the guide.

[0105] The embodiments in FIG. 24-26 are intended for use primarily in aclinical setting (e.g., while administering anesthesia in an operatingroom). The vast majority of surgical patients do not encountercomplications that would require intubation with an endotracheal tube.For these patients, a laryngeal mask airway 102 by itself is sufficientfor administering anesthesia. If the patient gets into trouble requiringintubation, the ventilation attachment 100 can be quickly added to theproximal end of the laryngeal mask airway 102 as shown in FIGS. 24 and25, and an endotracheal tube 40 can then be inserted through theventilation attachment 100 as shown in FIG. 27 and described above. Theembodiment of the ventilation attachment 100 depicted in FIG. 26, inparticular, would be simpler to manufacture and more cost effective forthis type of infrequent use.

[0106]FIG. 28 is a cross-sectional view of a guide 12 with a removableventilator connector 110 attached to its proximal end in place of theventilation attachment 100. The ventilation connector 110 has a standard15 mm diameter that allows the patient to be connected to a conventionalventilator. If the patient encountered difficulties requiringintubation, the ventilator connector 110 can be quickly removed from theguide 12 and replaced with the ventilation attachment 100 as shown inFIGS. 24-25.

[0107] The above disclosure sets forth a number of embodiments of thepresent invention. Other arrangements or embodiments, not precisely setforth, could be practiced under the teachings of the present inventionand as set forth in the following claims.

I claim:
 1. A laryngeal mask airway comprising: a curved tubular guidefor insertion through a patient's mouth and into the patient's airway,said guide having a distal opening to abut the patient's laryngeal inletand a proximal opening remaining outside the patient's mouth afterinsertion of the guide, said guide allowing insertion of an endotrachealtube along the guide to a position past the patient's larynx; alaryngeal mask surrounding the distal opening of the guide tosubstantially seal the laryngeal inlet about the distal opening of theguide; and a ventilation attachment removably attachable to the proximalopening of the guide having a ventilation port to supply a flow ofair/oxygen through the guide into the patient's lungs during insertionof an endotracheal tube along the guide.
 2. The laryngeal mask airway ofclaim 1 wherein the ventilation attachment further comprises: apassageway aligned with the guide allowing insertion of an endotrachealtube; and a ventilation port allowing air/oxygen to be supplied throughthe passageway and guide as the endotracheal tube is inserted.
 3. Thelaryngeal mask airway of claim 2 wherein the ventilation attachmentfurther comprises a seal ring within the passageway providing a sealaround the endotracheal tube as the endotracheal tube is insertedthrough the ventilation attachment to prevent air/oxygen from escapingfrom within the passageway but allowing the endotracheal tube to beadvanced through the ventilation attachment.
 4. The laryngeal maskairway of claim 2 wherein the ventilation attachment further comprises arotatable collar surrounding the passageway allowing the ventilationport to be rotated to any desired orientation about the ventilationattachment.
 5. The laryngeal mask airway of claim 1 wherein thelaryngeal mask further comprises: a lower portion shaped tosubstantially block the patient's esophagus below the patient'slaryngeal inlet; and an upper portion surrounding the distal opening ofthe guide and substantially filling the patient's laryngopharynxadjacent to the laryngeal inlet, wherein the laryngeal mask directs theguide along the patient's airway so that the distal opening of the guideabuts the patient's laryngeal inlet.
 6. The laryngeal mask airway ofclaim 1 further comprising a protrusion extending from an anteriorportion of the distal tip of the guide to push against the patient'svallecula and thereby lift the epiglottis from the laryngeal inlet. 7.The laryngeal mask airway of claim 1 wherein the laryngeal mask furthercomprises opposing side portions to pinch the patient's epiglottisbetween the side portions of the laryngeal mask as the guide is insertedinto the patient's laryngopharynx to thereby lift the epiglottis fromthe laryngeal inlet.
 8. The laryngeal mask airway of claim 1 wherein thelaryngeal mask is inflatable.
 9. The laryngeal mask airway of claim 1wherein the laryngeal mask comprises a soft, resilient material.
 10. Alaryngeal mask airway comprising: a curved tubular guide for insertionthrough a patient's mouth and into the patient's airway to allowinsertion of an endotracheal tube along the guide and through thepatient's larynx, said guide having a distal opening to abut thepatient's laryngeal inlet and a proximal opening remaining outside thepatient's mouth after insertion of the guide; and a laryngeal masksurrounding the distal opening of the guide to substantially seal thelaryngeal inlet about the distal opening of the guide, said laryngealmask having: (a) a support member extending from the distal end theguide and having a tip extending into the patient's esophagus; (b) aprotrusion to push against the patient's vallecula and thereby lift theepiglottis from the laryngeal inlet as the guide is inserted into thepatient's laryngopharynx; (c) a lower portion extending from the supportmember that is shaped to substantially block the patient's esophagusbelow the patient's laryngeal inlet and align the distal opening of theguide with the patient's laryngeal inlet as the guide is advanced alongthe patient's airway; (d) an upper portion extending from the supportmember and surrounding the distal opening of the guide to substantiallyfill the patient's laryngopharynx adjacent to the laryngeal inlet; and(e) opposing side portions to pinch the patient's epiglottis and therebylift the epiglottis from the laryngeal inlet, so that the distal openingof the guide abuts the patient's laryngeal inlet as the guide isadvanced along the patient's airway and is sealed in fluid communicationwith the patient's laryngeal inlet; and a ventilation attachmentremovably attachable to the proximal opening of the guide having aventilation port to supply air/oxygen through the guide during insertionof an endotracheal tube along the guide.
 11. The laryngeal mask airwayof claim 10 wherein the ventilation attachment further comprises: apassageway aligned with the guide allowing insertion of an endotrachealtube; and a ventilation port allowing air/oxygen to be supplied throughthe passageway and guide as the endotracheal tube is inserted.
 12. Thelaryngeal mask airway of claim 11 wherein the ventilation attachmentfurther comprises a rotatable collar surrounding the passageway allowingthe ventilation port to be rotated to any desired orientation about theventilation attachment.
 13. The laryngeal mask airway of claim 11wherein the ventilation attachment further comprises a seal ring withinthe passageway providing a seal around the endotracheal tube as theendotracheal tube is inserted through the ventilation attachment toprevent air/oxygen from escaping from within the passageway but allowingthe endotracheal tube to be advanced through the ventilation attachment.14. The laryngeal mask airway of claim 10 wherein the laryngeal mask isinflatable.
 15. A laryngeal mask airway comprising: a curved tubularguide for insertion through a patient's mouth and into the patient'sairway, said guide having a distal opening to abut the patient'slaryngeal inlet and a proximal opening remaining outside the patient'smouth after insertion of the guide, said guide allowing insertion of anendotracheal tube along the guide to a position past the patient'slarynx; a laryngeal mask surrounding the distal opening of the guide tosubstantially seal the laryngeal inlet about the distal opening of theguide; and a ventilation attachment having: (a) a passageway alignedwith the guide allowing insertion of an endotracheal tube; and (b) aventilation port allowing air/oxygen to be supplied to the patientthrough the passageway and guide as the endotracheal tube is insertedthrough the passageway and guide; and (c) a cuff removably attaching theventilation attachment to the proximal opening of the guide.
 16. Thelaryngeal mask airway of claim 15 wherein the ventilation attachmentfurther comprises a seal ring within the passageway providing a sealaround the endotracheal tube as the endotracheal tube is insertedthrough the ventilation attachment to prevent air/oxygen from escapingfrom within the passageway but allowing the endotracheal tube to beadvanced through the ventilation attachment.
 17. The laryngeal maskairway of claim 15 wherein the ventilation attachment further comprisesa rotatable collar surrounding the passageway allowing the ventilationport to be rotated to any desired orientation about the ventilationattachment.
 18. The laryngeal mask airway of claim 15 wherein thelaryngeal mask further comprises: a lower portion shaped tosubstantially block the patient's esophagus below the patient'slaryngeal inlet; and an upper portion surrounding the distal opening ofthe guide and substantially filling the patient's laryngopharynxadjacent to the laryngeal inlet, wherein the laryngeal mask directs theguide along the patient's airway so that the distal opening of the guideabuts the patient's laryngeal inlet.
 19. The laryngeal mask airway ofclaim 15 further comprising a protrusion extending from an anteriorportion of the distal tip of the guide to push against the patient'svallecula and thereby lift the epiglottis from the laryngeal inlet. 20.The laryngeal mask airway of claim 15 wherein the laryngeal mask furthercomprises opposing side portions to pinch the patient's epiglottisbetween the side portions of the laryngeal mask as the guide is insertedinto the patient's laryngopharynx to thereby lift the epiglottis fromthe laryngeal inlet.